1093934580 NPI number — PROF. DIANE LYNN COMPO MILOW

Table of content: PROF. DIANE LYNN COMPO MILOW (NPI 1093934580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093934580 NPI number — PROF. DIANE LYNN COMPO MILOW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMPO MILOW
Provider First Name:
DIANE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
DIANE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.N.M.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093934580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4701 TUXEDO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUND
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55364-9169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-472-0430
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COLLEGE OF ST. CATHERINE
Provider Second Line Business Practice Location Address:
2004 RANDOLPH AVE
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-690-6714
Provider Business Practice Location Address Fax Number:
651-690-6188
Provider Enumeration Date:
04/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  R 111945-3 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)